Abstract
Viscoelastic methods (VEM) made available the bedside assessment of blood clotting. Unlike standard laboratory tests, the results are based on the whole blood coagulation and are available in real time at a much faster turnaround time. In combination with our new knowledge about pathophysiology of the trauma-induced coagulopathy, the goal-oriented treatment protocols have been recently proposed for the initial management of bleeding in trauma victims. Additionally, the utility of viscoelastic monitoring devices has been proved even outside this setting in cardiosurgical patients or those undergoing liver transplantation. Many other situations were described in literature showing the potential use of bedside analysis of coagulation for the management of bleeding or critically ill patients. In the near future, we may expect further improvement in current bedside diagnostic tools enabling not only the assessment of secondary hemostasis but also the platelet aggregation. More sensitive assays for new anticoagulants are underway. Aim of this review is to offer the reader a multidisciplinary overview of VEM and their potential use in anesthesiology and critical care.
Highlights
IntroductionIntensive care medicine and anesthesia time are regarded as one of the most important factors affecting the patients’ outcome
In the contemporary emergency, intensive care medicine and anesthesia time are regarded as one of the most important factors affecting the patients’ outcome
Whether these novel modifications will help in elucidating the effect of other novel anticoagulants is still unresolved. These more specific tests are not clinically available and not routinely performed. This makes the assessment of anticoagulation via Viscoelastic methods (VEM) tests elusive
Summary
Intensive care medicine and anesthesia time are regarded as one of the most important factors affecting the patients’ outcome. Because the nature of acute critical illness is often changing in very rapid pace, many contemporary diagnostic tools are too slow and inappropriate to combine these two approaches of timely administered but goal-oriented treatments For this reason, several point-ofcare testing (POCT) devices were introduced into the clinical praxis in the last few years or decades. Even though similarities in parameters offered by these methods can be found, the numerical values are not directly interchangeable due to different methods of assessment of viscoelastic forces and time-wise definition of variables (Table 2; Figure 2) These widely used variables and other derived or calculated parameters are displayed in the devices, and some new variables are under development [8].
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